The mission of Prognosis is to explore the nexus at which healthcare policy meets healthcare practice and how one affects the other. This blog makes readers more aware of the innovations taking place in healthcare delivery, financing and technology and the types of public policies that will encourage further progress.

Healthcare In Focus is a public education initiative of the HLC, created to promote a constructive dialogue about the state and future of American healthcare.

There’s a new survey out today that brings comfort to those who strongly advocated the health reform legislation Congress passed earlier this year. The Kaiser Family Foundation poll shows that more Americans are shifting their sentiments regarding health reform toward support of the measure.

According to the survey, 48 percent of respondents have a favorable view toward the new law while 41 percent oppose it. This is a significant shift from the previous month in which the split went 41 percent favorable – 44 percent opposed.

But wait….

At the same time that Kaiser is showing a positive trend in public approval, the Rasmussen polling firm finds that a majority of Americans still want the health reform law repealed. In fact, Rasmussen has asked the repeal question every week since the legislation’s passage and has found that voters support repeal by an average margin of 19 points.

This is consistent with a Gallup/USA Today Poll earlier this month showing that political independents support repeal of health reform by a 17 point margin, 55 to 38 percent.

So what does this all mean? Not all that much, actually. It’s not surprising that some polls would find slightly growing levels of support. After all, the pieces of health reform that have been implemented thus far – “donut hole” payments to seniors and allowing young adults to stay on their parents’ insurance policies, for example – are painless, feel-good measures that won’t generate opposition. The tougher pieces of reform, such as the imposition of mandates, are yet to come.

Those of us who have commissioned polling know that results can change based on how you phrase questions and the composition of survey respondents.

What I find amusing are the media pundits who touted public opinion last year when polls showed support for a government health insurance opposition. Then, when polls turned against Congress’s health reform bill, they said it was irrelevant because people didn’t understand what was in the legislation. Now, they’re back applauding polls because of the change in results.

I’d prefer to be consistent and say that polling is largely irrelevant at this point until the health reform implementation process is farther along and we can actually see what impact the new law will have on the healthcare system, patients and consumers.

With eight out of every 10 over-65 adults having at least one chronic disease, and with chronic illnesses accounting for over 70 percent of our nation’s $2 trillion annual healthcare bill, Dr. Lorig’s program is a valuable one. The workshops and classes she initiated help chronic disease sufferers better communicate about their conditions engage in healthier lifestyles and do a more effective job handling their medication regimens.

The Kaiser interview caught my attention because Dr. Lorig makes an important point about the flaws in our healthcare system when it comes to treating many patients with chronic diseases. She said:

“Right now, it addresses diseases or even parts of diseases or small sub-parts of the body. It does not address the whole, complex person with multiple chronic diseases. So, right now, what happens, if you’re lucky, you go to a primary care doc who kind of does the day-to-day stuff and then you see four or five specialists each of which do their little specialty part — none of whom really talk to each other except maybe to look at your laboratory tests on an electronic medical record if you’re really lucky. It is totally uncoordinated. It’s chaotic. It serves pieces of people, not whole people.”

To be fair, there are a number of forward-thinking healthcare systems in the United States that have adopted coordinated care models and do an outstanding job bringing primary care physicians and specialists together to treat patients with a holistic approach. But, I can also attest personally, from overseeing my own father’s medical care, that there are too many cases where physicians aren’t communicating and don’t see the whole picture of a patient’s care when they recommend a new treatment or medication.

With over 50 percent of our senior population having multiple chronic diseases, it is clearly essential that coordinated care be the rule rather than the exception. And, as we move forward with the implementation of health reform, this has to be one of the most important priorities.

Last Friday in this space, we examined the impact public programs like Medicare and Medicaid, with their underpayments for healthcare services, are having on escalating healthcare costs for employers and private payers.

Now, USA Today, in today’s front page headline, is placing a spotlight on another Medicare-related problem. Seniors are having more difficulty finding physicians who will take Medicare patients, a problem only exacerbated by the current congressional stalemate over Medicare payment cuts.

According to the article, on average, Medicare only pays physicians 78 percent of what private insurers do. The American Academy of Family Physicians, the American Osteopathic Association and the American Medical Association all say that doctors are limiting their participation in the program.

John Rother, policy director for AARP, fears that this trend will serve to make the current shortage of primary care physicians even worse. He said this is a problem becoming increasingly visible in states like Illinois, North Carolina and New York.

We’re increasingly seeing the perils of an overreliance on public programs for coverage. Whether it’s cost-shifting to private payers, making healthcare more expensive for millions of Americans, or a reduction in access due to providers being unable to accept low reimbursements, the evidence is mounting that payment reform is essential to achieving a sustainable, workable healthcare system.

What’s instructive, in terms of setting future health policy, is why those costs are increasing.

According to PwC, hospital and physician costs will account for 81 percent of the health insurance premiums that employers are paying. And the reason those costs are escalating is because hospitals are being forced to shift more costs onto the backs of private payers and employers due to Medicare underpayments. PwC points out that this cost shifting is the primary driver behind higher healthcare costs for businesses.

I’ve always found it mind-boggling when policymakers argue that we can improve our healthcare system and our economy by moving more Americans into public coverage programs. With these programs paying less than the actual cost of delivering healthcare, someone else – employers and private payers, predominantly – has to pick up the slack. PwC points out that, with Medicare reducing payment rates to hospitals in 2011, this cost-shifting will exacerbate. This is not a positive development in an economy struggling to create jobs.

Cyril F. Chang, director of the Methodist Le Bonheur Center for Healthcare Economics, said in HealthLeaders Media that policymakers are trying to reduce healthcare expenditures by reducing Medicare payments. “Right now,” he said, “it seems to me the major instruments they are using to slow down the growth of cost are Medicare cutbacks.”

But we already know what results from this approach. Costs aren’t reduced, but merely shifted over to private payers. The real solution must come from meaningful healthcare delivery and payment reforms. As discussed in this space previously, many private sector providers are already succeeding with innovative delivery reforms. The challenge is to transform these localized successes into national policy, a process that needs to be placed on the fast track.

In yesterday’s New York Times, there was an interesting article about healthcare in Rwanda. The upshot of the piece was that 92 percent of Rwandans have health coverage, at a cost of just $2 per person per year. Then, in the early paragraphs of the story, came the obligatory potshot at the U.S. healthcare system, with a Rwandan editorial writer quoted as saying he had met an American college student passing through the country and found it “absurd, ridiculous that I have health insurance and she didn’t.”

In other words, it’s the same moral that the Times and other publications have been drilling into readers’ heads for some time now: Even poor nations have a better healthcare system than Americans do.

Then, you read down to the latter paragraphs of the article and a different picture emerges.

A Boston-based health charity, Partners in Health is operating two hospitals and a network of clinics throughout Rwanda and absorbing the costs. In fact, over half of the country’s healthcare costs are being covered by other countries, with the United States providing the greatest share.

And, even with this assistance, healthcare in Rwanda still has its tragic side. There is only one neurosurgeon and three cardiologists for a population of nearly 10 million. MRI scans and dialysis are virtually nonexistent and waits for general surgery can extend for weeks.

I’m not a trained journalist, but it strikes me that a more interesting lead to the story would concern the generosity of other countries and health providers, trying to raise the standards of healthcare in a third world country. That, to me, seems more to the point than another rehashing of the tired old cheap shots at healthcare in this country.